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Adolescents are often burdened with academic, home, and peer stressors. With adolescent mental health issues and suicide on the rise, administrators have worked with nonprofit organizations and the community to address stress and internalized behavior problems. School-based wellness centers are tranquil rooms with various sensory activities, calming nature scenes, and sounds for relaxation purposes. School-based wellness centers may have behavioral effects by reducing exposure to aversive events and increasing access to positive and negative reinforcers. There has not yet been a formal study of school-based wellness centers published in the literature. In the present study, we used questionnaires to examine the perceptions of 752 students, 124 parents, and 69 school staff of their high school wellness center. Results indicated that stakeholders had positive perceptions of the wellness center. In particular, results implied that stakeholders believed the wellness center contributed to students' academic success, elevation of mood, confidence, and coping skills. Results also suggested that attendance at the wellness center was associated with a decrease in student stress and anxiety, though recommendations for improvements were noted. Implications and limitations of this study are discussed., Author(s): Malka S. Moya [sup.1], Paul Caldarella [sup.1], Ross A. A. Larsen [sup.1], Jared S. Warren [sup.1], Jennifer R. Bitton [sup.2], Paul M. Feyereisen [sup.3] Author Affiliations: (1) grid.253294.b, 0000 [...]

Shared decision-making (SDM) is a part of patient-centered care, and it enables patient autonomy and preferences, which are the cornerstones of palliative care (PC) and end-of-life (EOL) care. SDM holds significant value in tailoring care to individual patient needs. This systematic literature review was designed to investigate the role of SDM within palliative care and end-of-life in the field of neurology. Relevant studies were retrieved from PubMed and Embase. Searches and data retrieval were conducted between June 23, 2023, and January 15, 2024, without date restrictions. All search terms yielded 429 articles; 33 were included. SDM, patient care preferences, and goals of care prominently directed the PC and EOL conversations. The themes of life extension versus prioritized comfort generated mixed results. Other themes included the nature and inception of advance care planning conversations, obstacles hindering these discussions, and the respective roles of health care providers and family caregivers. Lastly, a discrepancy in PC and EOL decisions was evident between patients, their families, and health care providers. There is a clear benefit for SDM for patients with neurologic diseases associated with PC and EOL decisions. However, there are several challenges, including the timing and depth of PC and EOL discussions while navigating the unpredictable trajectory of neurologic diseases and engaging in conversations with patients and their family members.

The tear meniscus height (TMH) along the lid margin is a clinical measure in the evaluation of patients with dry eyes and contact lens wearers. The morphology of the eyelid may differ among ethnic groups, potentially impacting the meniscus height, which can be useful for clinicians to optimize patient care.

Information is transmitted between brain regions through the release of neurotransmitters from long-range projecting axons. Understanding how the activity of such long-range connections contributes to behavior requires efficient methods for reversibly manipulating their function. Chemogenetic and optogenetic tools, acting through endogenous G-protein-coupled receptor pathways, can be used to modulate synaptic transmission, but existing tools are limited in sensitivity, spatiotemporal precision or spectral multiplexing capabilities. Here we systematically evaluated multiple bistable opsins for optogenetic applications and found that the Platynereis dumeriliiciliary opsin (PdCO) is an efficient, versatile, light-activated bistable G-protein-coupled receptor that can suppress synaptic transmission in mammalian neurons with high temporal precision in vivo. PdCO has useful biophysical properties that enable spectral multiplexing with other optogenetic actuators and reporters. We demonstrate that PdCO can be used to conduct reversible loss-of-function experiments in long-range projections of behaving animals, thereby enabling detailed synapse-specific functional circuit mapping.

The aims of this study were to determine whether tubulointerstitial damage in the form of interstitial fibrosis/tubular atrophy and total interstitial inflammation predicted progression to end stage renal disease (ESRD) and/or renal relapse (RR) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). One hundred thirteen patients with AAV from six French centers with an index biopsy performed between 2003 and 2013 were included. Histological assessments using the AAV glomerular classification and the kidney allograft Banff classification were performed on pathological review. Biopsy tissues were also investigated by CD3, CD20, CD68, CD163, FOXP3 and RORγt immunohistochemical staining. Competing risks models were calculated. Of the 113 patients, 26 (23.0%) died during follow-up and 29 (25.6%) developed ESRD. Among the 94 patients who achieved remission by the end of induction therapy without developing ESRD, 26 (27.6%) experienced RR. The two independent prognostic factors for ESRD were the estimated glomerular filtration rate at presentation (HR 0.35; 95% CI 0.23–0.51; P < 0.0001) and IF/TA > 25% (HR 2.27; 95% CI 1.18–4.37; P = 0.014). When the distribution of interstitial immune cell phenotypes was included in a second multivariable model, the organization of lymphocytic infiltrates was also an independent predictor of ESRD (HR 2.86; 95% CI 1.35–6.1, P = 0.006). The independent risk factors for RR were a higher CD3/CD20 ratio (HR 1.39; 95% CI 1.05–1.85; P = 0.02) and the presence of RORγt positive cells (HR 2.70; 95% CI 1.11–6.54; P = 0.02). Our results highlight the prognostic value of initial histological evaluations in AAV. Measurements of tubulointerstitial damage and interstitial immune cell phenotype distributions should be considered to improve risk assessments for ESRD and RR.

The COVID-19 pandemic had a monumental impact on the inflammatory bowel disease (IBD) community. At the beginning of the pandemic, knowledge on the effect of SARS-CoV-2 on IBD was lacking, especially in those with medication-suppressed immune systems. Throughout the pandemic, scientific literature exponentially expanded, resulting in clinical guidance and vaccine recommendations for individuals with IBD. Crohn’s and Colitis Canada established the COVID-19 and IBD Taskforce to process and communicate rapidly transforming knowledge into guidance for individuals with IBD and their caregivers, healthcare providers, and policy makers. Recommendations at the onset of the pandemic were based on conjecture from experience of prior viruses, with a precautionary principle in mind. We now know that the risk of acquiring COVID-19 in those with IBD is the same as the general population. As with healthy populations, advanced age and comorbidities increase the risk for severe COVID-19. Individuals with IBD who are actively flaring and/or who require high doses of prednisone are susceptible to severe COVID-19 outcomes. Consequently, sustaining maintenance therapies (e.g., biologics) is recommended. A three-dose mRNA COVID-19 vaccine regimen in those with IBD produces a robust antibody response with a similar adverse event profile as the general population. Breakthrough infections following vaccine have been observed, particularly as the virus continues to evolve, which supports receiving a bivalent vaccine booster. Limited data exist on the impact of IBD and its therapies on long-term outcomes following COVID-19. Ongoing research is necessary to address new concerns manifesting in those with IBD throughout the evolving pandemic.In April 2021, Crohn’s and Colitis Canada’s COVID-19 and IBD Taskforce produced the 2021 Impact of COVID-19 & Inflammatory Bowel Disease in Canada. This report summarized the key learnings of the impact of COVID-19 on the IBD community at the one-year anniversary since the COVID-19 pandemic was declared by the World Health Organization. During the first year of the pandemic, and before the widespread dissemination of COVID-19 vaccines, the body of the scientific literature was synthesized and communicated to the IBD community through Crohn’s and Colitis Canada’s COVID-19 and IBD Taskforce using online resources and a webinar series. The scientific literature from that time period suggested that those with IBD shared a similar risk of becoming infected by SARS-CoV-2 or experiencing severe outcomes as the general population with the primary exception being those flaring and/or requiring high doses of oral systemic corticosteroids. During the first year, lockdowns and shielding populations believed to be at high risk, like the IBD community, reduced the risk of transmission. However, mental health distress was prevalent due to isolation and uncertainty of risks, which was exacerbated in immunocompromised individuals with IBD. Major breakthroughs in novel SARS-CoV-2 vaccines and antiviral therapeutics, as well as adaptation to models of healthcare delivery (e.g., virtual care) offered hope that the second year of the pandemic would realize the easing of restrictions.This article reviews what we know about COVID-19 in 2023. It is an update to the 2021 Impact of COVID-19 and Inflammatory Bowel (IBD) Disease report. IBD is a disease that causes the intestines to be inflamed. Some medicine used to treat IBD can make a person more prone to infection. COVID-19 is an infection by the SARS-CoV-2 virus. So, it was once thought that people with IBD were at greater risk of COVID-19. We now know that people with IBD have the roughly same risk of COVID-19 as people without IBD. This is unless the person is on high dose steroids (>20 mg/day) or has an active IBD flare. The Crohn’s and Colitis Canada COVID-19 and IBD Taskforce assembled quickly at the beginning of the pandemic. They provided expert advise to the IBD community about COVID-19 and IBD and will keep doing so. We recommend people with IBD get a bivalent booster vaccine against COVID-19.

Rates of inflammatory bowel disease (IBD) in Canadian children and adolescents are among the highest in the world, and the incidence is rising most rapidly in children under five years of age. These young children may have either a typical form of IBD with multi-factorial aetiology, or they may have a monogenic form. Despite the growing number of children in Canada living with this important chronic disease, there are few available medical therapies approved by Health Canada due to the omission of children from most clinical trials of newly developed biologics. As a result, off-label use of medications is common, and physicians have learned to use existing therapies more effectively. In addition, most Canadian children are treated in multidisciplinary, specialty clinics by physicians with extra training or experience in IBD, as well as specialist nurses, dietitians, mental health care providers and other allied health professionals. This specialized clinic approach has facilitated cutting edge research, led by Canadian clinicians and scientists, to understand the causes of IBD, the optimal use of therapies, and the best ways to treat children from a biopsychosocial perspective. Canadians are engaged in work to understand the monogenic causes of IBD; the interaction between genes, the environment, and the microbiome; and how to address the mental health concerns and medical needs of adolescents and young adults transitioning from paediatric to adult care.This article reviews studies about inflammatory bowel disease (IBD) in children. IBD is an disease that causes inflamed intestines. Children are the fastest growing group that develop IBD. Not all drugs for IBD can be used by children. This is partly because children are not usually part of initial dug trials. Drug trials usually need to show safety in adults before they can be tested in children. Canadian researchers are leading the way in studies to improve care for children with IBD. They are doing this by creating care teams with specialists in different areas. These teams provide IBD care, mental healthcare, diet and nutrition plans and other important care. These care teams also help guide IBD specialists to find the right treatment for each person. The right treatment for each person means finding the right dose and the right course of therapies.

The therapeutic landscape for inflammatory bowel disease (IBD) has changed considerably over the past two decades, owing to the development and widespread penetration of targeted therapies, including biologics and small molecules. While some conventional treatments continue to have an important role in the management of IBD, treatment of IBD is increasingly moving towards targeted therapies given their greater efficacy and safety in comparison to conventional agents. Early introduction of these therapies—particularly in persons with Crohn’s disease—combining targeted therapies with traditional anti-metabolite immunomodulators and targeting objective markers of disease activity (in addition to symptoms), have been shown to improve health outcomes and will be increasingly adopted over time. The substantially increased costs associated with targeted therapies has led to a ballooning of healthcare expenditure to treat IBD over the past 15 years. The introduction of less expensive biosimilar anti-tumour necrosis factor therapies may bend this cost curve downwards, potentially allowing for more widespread access to these medications. Newer therapies targeting different inflammatory pathways and complementary and alternative therapies (including novel diets) will continue to shape the IBD treatment landscape. More precise use of a growing number of targeted therapies in the right individuals at the right time will help minimize the development of expensive and disabling complications, which has the potential to further reduce costs and improve outcomes.This article reviews studies on treatment for inflammatory bowel disease (IBD). IBD is a disease that causes the bowels to become inflamed. Many treatment options exist for people with IBD in Canada. Some of these options are drugs, surgery and diet. Many drugs used to treat IBD are very expensive. New biosimilar drugs may lower costs and increase how available these drugs are. It is very important to make sure that the right drug for the right person at the right time is found. New studies must seek to understand what the right treatments are for each person. We have come a long way in treating IBD over the last 60 or so years. However, people with IBD may still need surgery at some point. New drugs being tested offer hope that more ways to treat IBD will soon be available. We hope that these new drugs will prove safe an effective for people with IBD and reduce complications of disease.

Approximately one out of every 88 seniors has inflammatory bowel disease (IBD), and this is expected to increase in the future. They are more likely to have left-sided disease in ulcerative colitis, and isolated colonic disease in Crohn’s disease; perianal disease is less common. Other common diagnoses in the elderly must also be considered when they initially present to a healthcare provider. Treatment of the elderly is similar to younger persons with IBD, though considerations of the increased risk of infections and malignancy must be considered when using immune modulating drugs. Whether anti-TNF therapies increase the risk of infections is not definitive, though newer biologics, including vedolizumab and ustekinumab, are thought to be safer with lower risk of adverse events. Polypharmacy and frailty are other considerations in the elderly when choosing a treatment, as frailty is associated with worse outcomes. Costs for IBD-related hospitalizations are higher in the elderly compared with younger persons. When elderly persons with IBD are cared for by a gastroenterologist, their outcomes tend to be better. However, as elderly persons with IBD continue to age, they may not have access to the same care as younger people with IBD due to deficiencies in their ability to use or access technology.In 2018, one out of every 160 seniors had inflammatory bowel disease (IBD); 15% of all people with IBD are diagnosed over the age of 65. Seniors diagnosed with Crohn’s disease are more likely to have isolated colonic disease without fistulizations, compared with those diagnosed at a younger age. The use of thiopurines was associated with a higher risk of lymphoma when compared to those under the age of 50 exposed to thiopurines. The use of anti-TNF therapy was lower for both Crohn’s disease and ulcerative colitis, compared with younger people with IBD. Persons between the ages of 65–79 with IBD had higher health care costs when compared with age-matched controls.This article reviews studies about seniors with inflammatory bowel disease (IBD). IBD is a disease that causes the intestines to be inflamed. Seniors are people aged 65 years old or older. This is the fastest growing age group with IBD. In 2023, one in every 88 seniors in Canada has IBD. Care for seniors with IBD can be difficult. (i) Seniors often have other diseases due to their age. (ii) Seniors are often on many medicines that can interact. (iii) Seniors may have problems with access to care. Some problems seniors may face include technology, being able to get to clinics, or with medical risks. Some medicines used to treat IBD can make getting an infection more likely. We strongly recommend vaccines against COVID-19, shingles, and other diseases.

Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn’s disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.This article reviews studies about mental health concerns in people with inflammatory bowel disease (IBD). The primary focus of this article is on anxiety and depression. These mental health concerns are common in people with IBD. IBD is a disease that causes the intestines to be inflamed. Poor mental health occurs with active periods of IBD. Active periods of IBD also occur with periods of poor mental health. People with IBD are 1.5–2 times more likely to have a mental health disorder than people without IBD. Nearly one in three people with IBD have anxiety symptoms. Nearly one in four people with IBD have depression symptoms. We recommend screening for mental health concerns for children and adults with IBD. It is also important that pathways to address these mental health concerns are in place. Teams to care for those with IBD should include mental health experts.

Sex (the physical and physiologic effects resulting from having specific combinations of sex chromosomes) and gender (sex-associated behaviours, expectations, identities, and roles) significantly affect the course of inflammatory bowel disease (IBD) and the experience of living with IBD. Sex-influenced physiologic states, like puberty, the menstrual cycle, pregnancy, and andropause/menopause may also impact and be impacted by IBD.While neither Crohn’s disease nor ulcerative colitis is commonly considered sex-determined illnesses, the relative incidence of Crohn’s disease and ulcerative colitis between males and females varies over the life cycle. In terms of gender, women tend to use healthcare resources at slightly higher rates than men and are more likely to have fragmented care. Women are more commonly prescribed opioid medications and are less likely than men to undergo colectomy. Women tend to report lower quality of life and have higher indirect costs due to higher rates of disability. Women are also more likely to take on caregiver roles for children with IBD. Women with IBD are more commonly burdened with adverse mental health concerns and having poor mental health has a more profound impact on women than men.Pregnant people with active IBD have higher rates of adverse outcomes in pregnancy, made worse in regions with poor access to IBD specialist care. The majority of individuals with IBD in Canada do not have access to a pregnancy-in-IBD specialist; access to this type of care has been shown to allay fears and increase knowledge among pregnant people with IBD.This article reviews studies about sex / gender and inflammatory bowel disease (IBD). IBD is a disease that causes the intestines to inflame. The rate people develop IBD is not different for males and females. Differences between men, women, and gender diverse people can impact the course of IBD. Gender-diverse people and men are less likely to seek healthcare. Women are more likely to report mental health concerns. Some mental health concerns in IBD are anxiety and depression. Women are more likely to have IBD symptoms attributed to sex-based concerns like menstruation. Pregnant people with IBD may have a higher risk of poor pregnancy outcomes. People with IBD who wish to become pregnant should receive counseling. Counseling by pregnancy and IBD specialists could reduce a person’s risk of poor outcomes. There is not enough research on sex/gender and IBD. We need more research in these areas.

People living with inflammatory bowel disease (IBD) and their caregivers are faced with indirect and out-of-pocket costs that they would not otherwise experience. These costs impact one’s ability to contribute to the economy to their fullest potential. The indirect costs of IBD in Canada are estimated to be at least $1.51 billion in 2023 and include costs associated with lost productivity resulting from a combination of missed work (absenteeism), decreased workplace productivity (presenteeism), unemployment, premature mortality, and caregiving costs. Unemployment is the largest contributor to indirect costs ($1.14 billion), followed by costs of absenteeism and presenteeism ($285 million). Caregiving costs for children with IBD are estimated to be nearly $58 million. Canadians with IBD also pay $536 million every year for care that is not covered by universal or supplemental private health insurance; this includes allied healthcare (e.g., care provided by psychologists), medication, and other supportive therapy. Combined, the indirect and out-of-pocket costs of IBD in Canada are estimated at more than $2 billion CAD in 2023. This is substantially higher than the estimate of $1.29 billion in Crohn’s and Colitis Canada’s 2018 Impact of IBD report with differences attributable to a combination of rising prevalence, inflation, and the addition of presenteeism and caregiving costs to the total indirect costs.Inflammatory bowel disease (IBD) is very costly to people with IBD and society. The cost of IBD includes drugs, hospital stays, and surgery. It also includes lost productivity and out-of-pocket costs. Lost productivity can be starting a career later in life, retiring early, or lost work for sick time. Out-of-pocket costs include costs for travel to clinics, dietary needs, or medical supplies not covered by insurance. There are many other costs for care for people with IBD. In this article, we review lost productivity and out-of-pocket costs for IBD. In Canada, in 2023, these costs were at least $1.51 billion. Unemployment among people with IBD totaled roughly $1.14 billion. Costs of lost work time totaled roughly $285 million. Costs for childcare for children with IBD totaled nearly $58 million. Canadians with IBD also pay $536 million yearly for care not covered insurance. Combined, these costs for IBD in Canada will be more than $2 billion this year. up from roughly $1.29 billion in 2018. This increase is because people have IBD, inflation, and additional costs of IBD.

Healthcare utilization among people living with inflammatory bowel disease (IBD) in Canada has shifted from inpatient management to outpatient management; fewer people with IBD are admitted to hospitals or undergo surgery, but outpatient visits have become more frequent. Although the frequency of emergency department (ED) visits among adults and seniors with IBD decreased, the frequency of ED visits among children with IBD increased. Additionally, there is variation in the utilization of IBD health services within and between provinces and across ethnocultural and sociodemographic groups. For example, First Nations individuals with IBD are more likely to be hospitalized than the general IBD population. South Asian children with Crohn’s disease are hospitalized more often than their Caucasian peers at diagnosis, but not during follow-up. Immigrants to Canada who develop IBD have higher health services utilization, but a lower risk of surgery compared to individuals born in Canada. The total direct healthcare costs of IBD, including the cost of hospitalizations, ED visits, outpatient visits, endoscopy, cross-sectional imaging, and medications are rising rapidly. The direct health system and medication costs of IBD in Canada are estimated to be $3.33 billion in 2023, potentially ranging from $2.19 billion to $4.47 billion. This is an increase from an estimated $1.28 billion in 2018, likely due to sharp increases in the use of biologic therapy over the past two decades. In 2017, 50% of total direct healthcare costs can be attributed to biologic therapies; the proportion of total direct healthcare costs attributed to biologic therapies today is likely even greater.It is expensive to care for people with inflammatory bowel disease (IBD). IBD may make a person need to go to the hospital, take medicine, or have surgery. The cost of caring for people with IBD has been growing over the past 20 years. This is partly because of more expensive medicines called biologics. Biologics started being used in Canada in 2001 and are now very common. Now, biologics make up more than half the total cost of treating IBD. In 2018, we believe that the total cost of hospitals, surgeries and medicines to treat IBD was $1.28 billion. Today, in 2023, we estimate that the total cost to treat IBD is roughly $3.33 billion.In this article, we have gathered data from published studies that let us evaluate the current cost of caring for IBD in Canada. We show how different people, such as indigenous people with IBD, people with IBD living inside or outside of cities, or children with IBD use Canadian healthcare systems in different ways, and how that affects the cost to care for people with IBD. We need to understand these costs to make sure we can continue providing the best care for people with IBD.

Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56–66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.This article reviews studies on access to and models of care for people with inflammatory bowel disease (IBD). IBD is a disease that causes the intestines to become inflamed. People with IBD report problems with access to care. These include access to virtual, specialist and diverse care. Diverse care is provided by a team with multiple specialists. Some specialists may include IBD physicians, dietitians, mental health care providers and others. Access to virtual care is very important to people living in rural and Northern areas. It is also important to those without local specialist care. Part of diverse care is access to new tools like intestinal ultrasound. Ultrasound is often preferred by people with IBD to other tests of disease activity. Ultrasound requires less prep and less time. People with IBD should have a say in how they receive care. Having access to virtual and diverse care can have a large impact. This impact helps people with IBD, IBD care providers and health care systems. People with IBD may see better health outcomes. IBD care providers can offer better treatment options. Health care systems may see cost savings as a result.

Cancer is a major cause of morbidity and mortality among people with inflammatory bowel disease (IBD). Intestinal cancers may arise as a complication of IBD itself, while extra-intestinal cancers may arise due to some of the immunosuppressive therapies used to treat IBD. Colorectal cancer (CRC) and small bowel cancer risks remain elevated among persons with IBD as compared to age-and sex-matched members of the general population, and the lifetime risk of these cancers is strongly correlated to cumulative intestinal inflammatory burden. However, the cumulative risk of cancer, even among those with IBD is still low. Some studies suggest that IBD-CRC incidence has declined over the years, possibly owing to improved treatment standards and improved detection and management of early neoplastic lesions. Across studies of extra-intestinal cancers, there are generally higher incidences of melanoma, hepatobiliary cancer, and lung cancer and no higher incidences of breast cancer or prostate cancer, with equivocal risk of cervical cancer, among persons with IBD. While the relative risks of some extra-intestinal cancers are increased with treatment, the absolute risks of these cancers remain low and the decision to forego treatment in light of these risks should be carefully weighed against the increased risks of intestinal cancers and other disease-related complications with undertreated inflammatory disease. Quality improvement efforts should focus on optimized surveillance of cancers for which surveillance strategies exist (colorectal cancer, hepatobiliary cancer, cervical cancers, and skin cancers) and the development of cost-effective surveillance strategies for less common cancers associated with IBD.This article reviews studies about the risk of cancer in people with inflammatory bowel disease (IBD). IBD is a disease that causes the intestines to become inflamed. Long-term inflammation that is not treated can lead to certain cancers. Thus, there is a higher risk of cancer in people with IBD than in people without IBD. It must be said that the overall risk of cancer in people with IBD is still low. There are some drugs used to treat IBD that may also make cancer risk higher for people with IBD. Even with an increased risk of cancer due to some drugs, properly treated IBD decreases cancer risk. People with IBD should have regular screening for cancer during follow-ups with their physicians. Regular high-quality screening can reduce the risk of cancer. People concerned about cancer risk due to drugs used to treat IBD should talk with their physicians. During this talk, they can be part of shared decision-making about treatment and risks.

The burden of inflammatory bowel disease (IBD) (i.e., associated direct and indirect costs, prevalence of disease, personal impact to the individual and to caregivers) continues to increase in Canada. The prevalence of IBD has increased since Crohn’s and Colitis Canada’s 2018 Impact of IBD report from an estimated 270,000 Canadians living with IBD in 2018 to an estimated 322,600 Canadians living with IBD today in 2023. Consequently, associated costs of IBD have also dramatically increased from an estimated $2.57 billion in 2018 to an estimated $5.38 billion in 2023; this increase is due to multiple factors including increased prevalence of disease, inflation, and additional identified factors (e.g., presenteeism, costs of childcare). Beyond the economic impact of IBD, these diseases have a significant impact on people living with the disease and their caregivers, including different presentations of disease, different commonly associated extra-intestinal manifestations or comorbid conditions, and different barriers to accessing care. In this supplementary issue, we review: Evolving trends in the epidemiology of IBD; updated estimates of indirect and direct costs (including out-of-pocket costs) associated with IBD; information specific to IBD in children, adolescents, and seniors; issues related to IBD pertaining to sex and gender; information specific to risks associated with COVID-19 and cancer related to IBD; an overview of current treatments for IBD; and evolving care models, including access to care.Inflammatory bowel disease (IBD) affects many people. IBD is a disease that causes the intestines to become inflamed. This impact of IBD includes the number of people living with IBD, the cost to treat IBD, and personal impact on people living with IBD and their families. The burden of IBD is rising in Canada. In 2018, roughly 270,000 Canadians were living with IBD. In 2023, roughly 322,600 Canadians are living with IBD. The costs to treat people with IBD are also rising. Treating IBD cost roughly $2.57 billion in 2018. In 2023, treating IBD costs roughly $5.38 billion. This increase is because more people are living with IBD. Costs have also increased. Further, we include extra factors in the cost—like the cost of childcare. IBD also has a major impact on people living with the disease. The effects of the disease can be different for children versus seniors or others with IBD. Other medical conditions may be more common for people with IBD, such as cancer or infections. Also, different groups like Indigenous people or people living outside of cities may have problems accessing care. These and other issues about the care of IBD are reviewed in this summary.

Inflammatory bowel disease (IBD), consisting of Crohn’s disease and ulcerative colitis, is recognized across the world, though Canada has among the highest burdens of IBD in the world. The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) led a six-province study that demonstrated the compounding prevalence of IBD in Canada from 400 per 100,000 in 2002 to 636 per 100,000 in 2014. The prevalence in 2023 is estimated at 825 per 100,000, meaning that over 320,000 people in Canada are living with IBD. Prevalence is forecasted to rise by 2.44% per year such that 1.1% of the population, 470,000 Canadians, will live with IBD by 2035. The overall incidence of IBD in 2023 is 30 per 100,000 person-years, indicating that over 11,000 Canadians will be newly diagnosed with IBD in 2023. Incidence is forecasted to rise by 0.58% per year up to 32.1 per 100,000 by 2035. The rising incidence of IBD is propelled by pediatric-onset IBD, which is rising by 1.23% per year from 15.6 per 100,000 in 2023 to 18.0 per 100,000 in 2035. In contrast, incidence rates among adults and seniors are relatively stable. Understanding the determinates of IBD has expanded through prospective cohort studies such as the Crohn’s and Colitis Canada Genetic, Environmental, Microbial (CCC-GEM) project. Consensus recommendations towards diet, lifestyle, behavioural and environmental modifications have been proposed by international organizations with the goal of optimizing disease control and ultimately preventing the development of IBD. Despite these efforts, Canadian healthcare systems will need to prepare for the rising number of people living with IBD.Inflammatory bowel disease (IBD) is a disease that causes the intestines to inflame. IBD is something that is found in every country around the world. We have the highest number of people with IBD in the world compared to the total population. In 2002, one in every 250 (119,000) Canadians had IBD. In 2023, one in every 121 (320,000) Canadians has IBD. By 2035, one in every 91 (470,000) Canadians will have IBD. Roughly 11,000 Canadians will develop IBD in 2023. Rates of children developing IBD are rising. The rates of adults developing IBD are not changing. The rates of seniors developing IBD are also not changing. New research looks for better ways to care for IBD. New research also looks for ways to prevent IBD. One such project is Crohn’s and Colitis Canada Genetic, Environmental, Microbial project. This research suggests diet and lifestyle changes to improve the lives of people with IBD. The same changes may help reduce the number of people who develop IBD.

The word “elective” refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.

This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure’s success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success (P= 0.65) or adverse events rates (P= 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups (P> 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P= 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.

Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.

To solve recurring problems in drug discovery, matched molecular pair (MMP) analysis is used to understand relationships between chemical structure and function. For the MMP analysis of large data sets (>10,000 compounds), available tools lack flexible search and visualization functionality and require computational expertise. Here, we present Matcher, an open-source application for MMP analysis, with novel search algorithms and fully automated querying-to-visualization that requires no programming expertise. Matcher enables unprecedented control over the search and clustering of MMP transformations based on both variable fragment and constant environment structure, which is critical for disentangling relevant and irrelevant data to a given problem. Users can exert such control through a built-in chemical sketcher and with a few mouse clicks can navigate between resulting MMP transformations, statistics, property distribution graphs, and structures with raw experimental data, for confident and accelerated decision making. Matcher can be used with any collection of structure/property data; here, we demonstrate usage with a public ChEMBL data set of about 20,000 small molecules with CYP3A4 and/or hERG inhibition data. Users can reproduce all examples demonstrated herein via unique links within Matcher’s interface–a functionality that anyone can use to preserve and share their own analyses. Matcher and all its dependencies are open-source, can be used for free, and are available with containerized deployment from code at https://github.com/Merck/Matcher. Matcher makes large structure/property data sets more transparent than ever before and accelerates the data-driven solution of common problems in drug discovery.

The article focuses on the positive impact of wellness centers in schools, particularly in addressing student stress, anxiety, and emotional struggles. Topics discussed include the significant improvements in student attendance, the role of dedicated staffing, and the importance of involving stakeholders in the planning and implementation of wellness centers to enhance their effectiveness.

On November 13, 2013, a document containing a complete draft of the Trans-Pacific Partnership (TPP) agreement's chapter on Intellectual Property Rights was leaked to the world through the WikiLeaks Web [...]

Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.

ObjectiveThe measure of serum proteome in the preclinical state of Crohn’s disease (CD) may provide insight into biological pathways involved in CD pathogenesis. We aimed to assess associations of serum proteins with future CD onset and with other biomarkers predicting CD risk in a healthy at-risk cohort.DesignIn a nested case–control study within the Crohn’s and Colitis Canada Genetics Environment Microbial Project (CCC-GEM) cohort, which prospectively follows healthy first-degree relatives (FDRs), subjects who developed CD (n=71) were matched with four FDRs remaining healthy (n=284). Using samples at recruitment, serum protein profiles using the Olink Proximity Extension Assay platform was assessed for association with future development of CD and with other baseline biomarkers as follows: serum antimicrobial antibodies (AS: positive antibody sum) (Prometheus); faecal calprotectin (FCP); gut barrier function using the fractional excretion of lactulose-to-mannitol ratio (LMR) assay.ResultsWe identified 25 of 446 serum proteins significantly associated with future development of CD. C-X-C motif chemokine 9 (CXCL9) had the highest OR with future risk of CD (OR=2.07 per SD, 95% CI 1.58 to 2.73, q=7.9e-5), whereas matrix extracellular phosphoglycoprotein had the lowest OR (OR 0.44, 95% CI 0.29 to 0.66, q=0.02). Notably, CXCL9 was the only analyte significantly associated with all other CD-risk biomarkers with consistent direction of effect (FCP: OR=2.21; LMR: OR=1.67; AS: OR=1.59) (q<0.05 for all).ConclusionWe identified serum proteomic signatures associated with future CD development, reflecting potential early biological processes of immune and barrier dysfunction.

Previous investigations into the effect of mindfulness meditation on false memory have reported mixed findings. One potential issue is that mindfulness meditation involves different styles that establish distinct cognitive control states. The present work aimed to address this issue by comparing the effects of single-session focused attention (FAM) and open monitoring (OMM) mindfulness meditation styles on true and false memory recall. Strengthened cognitive control states associated with FAM were predicted to increase true memory recall and decrease false memory recall. Conversely, weakened cognitive control established by OMM was predicted to increase false memory recall. Thirty-four meditation-naïve participants (23 females, mean age = 23.4 years, range = 18–33) first completed pre-meditation learning and recall phases of the Deese-Roediger-McDermott (DRM) task. Participants then completed a single session of FAM or OMM prior to a second, post-meditation, round of DRM task learning and recall phases with a novel word list. Finally, participants completed a recognition test with true and false memory, and distractor words. Both FAM and OMM groups demonstrated significant increase in false memory recall between pre- and post-meditation recall tests but these groups did not differ with respect to true and false memory recall and recognition. The present findings are consistent with previous reports of increased false memory arising from mindfulness meditation. Distinct cognitive control states associated with FAM and OMM states do not result in distinct true and false memory formation, at least in meditation-naïve adults.

ObjectiveTo determine whether the use of proton pump inhibitors (PPIs) compared with the use of histamine-2 receptor antagonists (H2RAs) is associated with an increased risk of inflammatory bowel disease (IBD).DesignPopulation-based cohort study designed to address the impact of protopathic bias.SettingGeneral practices contributing data to the UK Clinical Practice Research Datalink GOLD.Participants1 498 416 initiators of PPIs and 322 474 initiators of H2RAs from 1 January 1990 to 31 December 2018, with follow-up until 31 December 2019. Patients were analysed according to the timing of the IBD diagnosis after treatment initiation (early vs late).Main outcome measuresStandardised morbidity ratio weighted Cox proportional hazards models were used to estimate marginal HRs and 95% CIs. In the early-event analysis, IBD diagnoses were assessed within the first 2 years of treatment initiation, an analysis subject to potential protopathic bias. In the late-event analysis, all exposures were lagged by 2 years to account for latency and minimise protopathic bias.ResultsIn the early-event analysis, the use of PPIs was associated with an increased risk of IBD within the first 2 years of treatment initiation, compared with H2RAs (HR 1.39, 95% CI 1.14 to 1.69). In contrast, the use of PPIs was not associated with an increased risk of IBD in the late-event analysis (HR 1.05, 95% CI 0.90 to 1.22). The results remained consistent in several sensitivity analyses.ConclusionsCompared with H2RAs, PPIs were not associated with an increased risk of IBD, after accounting for protopathic bias.

This study aimed to examine differences between evacuee and non-evacuee parents regarding their experiences following the October 7th terror attack in Israel, and to assess how parental factors—such as exposure, PTS, functioning, resilience, and trust in authorities—were related to perceived behavioral problems in children. The study included 221 evacuee parents and 262 non-evacuee parents, recruited online through a professional survey company. We hypothesized that perceived child aggression and social problems would increase following the terrorist events, with evacuee parents reporting a greater increase in symptoms due to heightened instability and stress. Additionally, we expected higher levels of parental exposure, PTS, impaired functioning, lower resilience, and lower trust in authorities to be associated with increased child aggression and social problems. Results indicated that evacuee parents reported significantly more perceived aggression and social problems in their children, along with lower functioning, higher PTS, and lower trust in authorities. However, regression analysis revealed that higher parental exposure, PTS, and lower functioning were associated with increased perceived child aggression and social problems, regardless of evacuee status. These findings highlight the need for targeted interventions to support evacuated families, rebuild trust in authorities, and strengthen community resilience to mitigate long-term impacts.

•This systematic review found patients preferred shared decision-making (SDM).•Preferred SDM was particularly true in multiple sclerosis and underserved populations.•SDM is important to ensure healthcare is accessible to underserved populations.•SDM can lead to a positive impact on the patient and their disease.•Not utilizing SDM can lead to patient dissatisfaction and decisional regret.

I. INTRODUCTION The enforcement of intellectual property law is a continuing, evergrowing, and challenging task for countries around the world. In response to the challenges faced, enforcement issues have arisen [...], A few developed countries have secretly initiated and negotiated the Anti-Counterfeiting Trade Agreement (ACTA). The ACTA is aimed at enhancing international copyright and trademark enforcement measures. This Article analyses the copyright dimension of ACTA, considering its various provisions and the rationale behind them. The Article does so by thoroughly examining the complex intersection of intellectual property law and criminal law. The Article then draws a few major conclusions and makes contributions to the area of copyright law: it shows how the ACTA in fact merely mimics the U.S. approach towards criminal enforcement of copyright law. Second, and more importantly, it illustrates how the ACTA initiative is therefore flawed in light of the U.S. experience to date with criminal enforcement of copyright law. Lastly, the Article makes a normative contribution by suggesting a better, education-based approach concerning criminal enforcement of copyright law.

OBJECTIVE--Whether nicotine leads to a persistent increase in blood glucose levels is not clear. Our objective was to assess the relationship between cotinine, a nicotine metabolite, and glycated hemoglobin (HbA1c), [...]

(Abstracted from Urogynecology2024;30:50–58Pelvic organ prolapse can be effectively treated with the nonsurgical use of pessaries. Some minor adverse effects occur with the use of this treatment, such as bleeding, vaginal discharge, and pessary extrusion.

Genome-wide association studies (GWASs) have identified hundreds of loci associated with Crohn’s disease (CD). However, as with all complex diseases, robust identification of the genes dysregulated by noncoding variants typically driving GWAS discoveries has been challenging. Here, to complement GWASs and better define actionable biological targets, we analyzed sequence data from more than 30,000 patients with CD and 80,000 population controls. We directly implicate ten genes in general onset CD for the first time to our knowledge via association to coding variation, four of which lie within established CD GWAS loci. In nine instances, a single coding variant is significantly associated, and in the tenth, ATG4C, we see additionally a significantly increased burden of very rare coding variants in CD cases. In addition to reiterating the central role of innate and adaptive immune cells as well as autophagy in CD pathogenesis, these newly associated genes highlight the emerging role of mesenchymal cells in the development and maintenance of intestinal inflammation.

BACKGROUND:In the last few decades, the revised diagnostic criteria for multiple sclerosis (MS) and the development of numerous new MS therapies have created the possibility of early diagnosis and opportune MS management. However, these changes, and the mounting emphasis on patient choice and shared decision making, have not been accompanied by improvements in information provided to patients with MS (PwMS). Information provision for PwMS increases disease-related knowledge that may assist them in decision making and quality of life. The purpose of this study was to validate the Multiple Sclerosis and Magnetic Resonance Imaging Knowledge Questionnaire (MSMRIKQ) to improve patients' shared decision-making capabilities. METHODS:In this methodological study, the instrument development process was completed in 4 stages using principles of measurement theory: (1) establishing a pool of items after patient and clinician panels' review, (2) evaluating the validity of the scale—both face and content validity, (3) pilot testing the scale, and (4) post–pilot testing statistical analysis of items and scale reliability and validity. RESULTS:The 20-item instrument was finalized based on a panel of MS experts' and patients' comments. The final version of the MSMRIKQ was pilot tested with a sample of 46 PwMS. Face validity was established on all MSMRIKQ items. Individual item-level and scale-level content validity indices for universal agreement estimates were acceptable at item-level content validity index = 1 and scale-level content validity index = 1 for the 20 items. The Kuder-Richardson 20 reliability estimate for the entire scale was 0.58; the Kuder-Richardson 20 estimates for the subscales of MS and magnetic resonance imaging knowledge were 0.35 and 0.51, respectively. The split-half reliability with Spearman-Brown correction for the total scale was 0.60. The Poisson regression model was significant for predicting MS knowledge within this population. CONCLUSION:The MSMRIKQ is a basic knowledge instrument for clinical and research use.

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The interaction of emitters with plasmonic cavities (PCs) has been studied extensively during the past decade. Much of the experimental work has focused on the weak coupling regime, manifested most importantly by the celebrated Purcell effect, which involves a modulation of the spontaneous emission rate of the emitter due to interaction with the local electromagnetic density of states. Recently, there has been a growing interest in studying hybrid emitter-PC systems in the strong-coupling (SC) regime, in which the excited state of an emitter hybridizes with that of the PC to generate new states termed polaritons. This phenomenon is termed vacuum Rabi splitting (VRS) and is manifested in the spectrum through splitting into two bands.

The graduate medical education (GME) system is heavily subsidized by the public in return for producing physicians who meet society’s needs. Under the terms of this implicit social contract, decisions about how this funding is allocated are deferred to the individual training sites. Institutions receiving public funding face potential conflicts of interest, which have at times prioritized institutional purposes and needs over societal needs, highlighting that there is little public accountability for how such funding is used. The cost and institutional burden of assessing many fundamental GME outcomes, such as specialty, geographic physician distribution, training-imprinted cost behaviors, and populations served, could be mitigated as data sources and methods for assessing GME outcomes and guiding training improvement already exist. This new capacity to assess system-level outcomes could help institutions and policymakers strategically address the greatest public needs. Measurement of educational outcomes can also be used to guide training improvement at every level of the educational system (i.e., the individual trainee, individual teaching institution, and collective GME system levels). There are good examples of institutions, states, and training consortia that are already assessing and using GME outcomes in these ways. The ultimate outcome could be a GME system that better meets the needs of society and better honors what is now only an implicit social contract.

To evaluate national trends in apical prolapse surgery with and without uterine preservation using the National Surgical Quality Improvement Program (NSQIP) database.

Therapeutic peptides offer potential advantages over small molecules in terms of selectivity, affinity, and their ability to target “undruggable” proteins that are associated with a wide range of pathologies. Despite their importance, current molecular design capabilities that inform medicinal chemistry decisions on peptide programs are limited. More specifically, there are unmet needs for structure–activity relationship (SAR) analysis and visualization of linear, cyclic, and cross-linked peptides containing non-natural motifs, which are widely used in drug discovery. To bridge this gap, we developed PepSeA (Peptide Sequence Alignment and Visualization), an open-source, freely available package of sequence-based tools (https://github.com/Merck/PepSeA). PepSeA enables multiple sequence alignment of non-natural amino acids and enhanced visualization with the hierarchical editing language for macromolecules (HELM). Via stepwise SAR analysis of a ChEMBL peptide data set, we demonstrate the utility of PepSeA to accelerate decision making in lead optimization campaigns in pharmaceutical setting. PepSeA represents an initial attempt to expand cheminformatics capabilities for therapeutic peptides and to enable rapid and more efficient design-make-test cycles.